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首页> 外文期刊>The American Journal of Cardiology >Impact of multiple complex plaques on short- and long-term clinical outcomes in patients presenting with ST-segment elevation myocardial infarction (from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI] Trial)
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Impact of multiple complex plaques on short- and long-term clinical outcomes in patients presenting with ST-segment elevation myocardial infarction (from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI] Trial)

机译：ST段抬高型心肌梗死患者中多种复合斑块对短期和长期临床结局的影响（来自急性心肌梗死的血运重建和支架联合治疗[HORIZONS-AMI]试验​​）

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摘要

It is not known whether the extent and severity of nonculprit coronary lesions correlate with outcomes in patients with ST-segment elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention (PCI). We sought to quantify complex plaques in patients with STEMI referred for primary PCI and to determine their effect on short- and long-term clinical outcomes by examining the core laboratory database for plaque analysis from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction study. Baseline demographic, angiographic, and procedural details were compared between patients with single versus multiple complex plaques who underwent single-vessel PCI. Multivariable analysis was performed for predictors of long-term major adverse cardiac events (MACEs), a combined end point of death, reinfarction, ischemic target-vessel revascularization, or stroke, and for death alone. Single-vessel PCI was performed in 3,137 patients (87%): 2,174 (69%) had multiple complex plaques and 963 (31%) had a single complex plaque. Compared with those with a single complex plaque, patients with multiple complex plaques were older (p <0.0001) and had more co-morbidities. The presence of multiple complex plaques was an independent predictor of 3-year MACE (hazard ratio 1.58, 95% confidence interval 1.26 to 1.98, p <0.0001), and death alone (hazard ratio 1.68, 95% confidence interval 1.05 to 2.70, p = 0.03). In conclusion, multiple complex plaques are present in the majority of patients with STEMI who underwent primary PCI, and their presence is an independent predictor of short- and long-term MACE, including death (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction; NCT00433966).
机译：对于原先经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者，非罪犯冠状动脉病变的程度和严重程度是否与预后相关尚不明确。我们试图通过对核心实验室数据库进行血栓分析与急性心肌梗死的血运重建和支架治疗相一致的研究，从而对定量用于原发性PCI的STEMI患者的复杂斑块进行量化，并确定其对短期和长期临床结果的影响。 。比较接受单支血管PCI的单个或多个复杂斑块患者的基线人口统计学，血管造影和手术细节。对长期重大心脏不良事件（MACE），死亡，再梗塞，局部缺血性靶血管血运重建或中风的综合终点进行了多变量分析，并且仅就死亡而言。 3,137例患者（87％）进行了单支血管PCI：2,174例（69％）具有多个复杂斑块，963例（31％）具有单个复杂斑块。与具有单个复杂斑块的患者相比，具有多个复杂斑块的患者年龄更大（p <0.0001），并发合并症。多个复杂斑块的存在是3年MACE（危险比1.58，95％置信区间1.26至1.98，p <0.0001）和单独死亡（危险比1.68，95％置信区间1.05至2.70，p）的独立预测因子。 = 0.03）。总之，大多数接受原发性PCI的STEMI患者中均存在多个复杂的斑块，并且它们的存在是短期和长期MACE的独立预测因子，包括死亡（在急性心肌梗死中与血运重建和支架相协调的结果; NCT00433966）。

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